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PubMed1999

Factors associated with prognosis for survival and athletic use in foals with septic arthritis: 93 cases (1987-1994).

OBJECTIVE: To identify factors affecting the prognosis for survival and athletic use in foals with septic arthritis. DESIGN: Retrospective study. ANIMALS: 93 foals with septic arthritis. PROCEDURE: Medical records were reviewed to obtain clinical findings, laboratory test results, radiographic findings, treatment method, and outcome. Race records for Thoroughbreds and Standardbreds were evaluated to determine whether foals subsequently raced and whether they raced successfully. RESULTS: 43 foals had 1 affected joint, 44 foals had multiple affected joints, and number of affected joints was not recorded for 6 foals. The femoropatellar and tarsocrural joints were most commonly affected. Osteomyelitis or degenerative joint disease were detected in 59% (46/78) of foals. Failure of passive transfer, pneumonia, and enteritis were common. Foals were treated with lavage, lavage and intra-articular administration of antibiotics, lavage and arthroscopic debridement with or without partial synovectomy, or lavage and arthrotomy to debride infected bone and systemic administration of antibiotics. Seventy-three foals survived to be discharged from hospital, and approximately a third raced. Isolation of Salmonella spp from synovial fluid was associated with an unfavorable prognosis for survival and multisystem disease was associated with an unfavorable prognosis for survival and ability to race; other variables were not significantly associated with survival and ability to race. CONCLUSIONS AND CLINICAL RELEVANCE: With treatment, the prognosis for survival of foals with septic arthritis was favorable, whereas prognosis for ability to race was unfavorable. Multisystem disease, isolation of Salmonella spp from synovial fluid, involvement of multiple joints, and synovial fluid neutrophil count > or = 95% at admission may be of prognostic value.

Animals↗
PubMed2000

[Therapeutic strategy and long-term prognosis of acute coronary syndrome].

The relation between initial therapeutic strategy and long-term prognosis was reviewed in patients with acute coronary syndrome. In the Q wave infarction, the effectiveness of reperfusion therapy has been established. The earlier ischemic myocardium is reperfused, the better is its prognosis. The long-term prognosis becomes better when TIMI 3 flow is obtained after the reperfusion therapy. Direct PTCA, which can obtain TIMI 3 flow in more than 90% of the patients, has showed lower mortality, lower rate of reocclusion and lower rate of cerebrovascular accident than thrombolytic therapy. As for the long-term efficacy of stent implantation, several more years are needed although early outcomes of primary stenting are impressive. The lesions in patients with non-Q wave myocardial infarction or unstable angina frequently show severe stenosis with platelet-rich thrombi. This type of lesion is thought to be unstable and the chance of cardiac events are high when percutaneous intervention or bypass surgery is performed during this period. Thus, the conservative strategy with waiting for 1 to 2 weeks to stabilize the plaque has been recommended. However, in the long span, the prognosis of unstable angina seems not bad after the complicated early course. The long-term prognosis of unstable angina could be affected by the early outcome.

Angina, Unstable↗
PubMed2001

Impact of diabetes mellitus on the prognosis of patients with hepatocellular carcinoma.

BACKGROUND: The majority of patients with hepatocellular carcinoma (HCC) have coexisting cirrhosis or chronic hepatitis, often complicated by diabetes mellitus. In the current study, the authors evaluated the impact of diabetes mellitus on the prognosis of patients with HCC. METHODS: Among 581 patients with HCC who had been diagnosed and treated between 1990 and 1999, survival was compared between those patients with and those patients without diabetes mellitus. The rate of disease recurrence after treatment also was analyzed. RESULTS: Ninety-two patients (15.8%) had diabetes mellitus. There was no significant difference with regard to patient characteristics (i.e., age, gender, or alcohol intake) or liver function between those patients with and those patients without diabetes mellitus. No differences were observed in survival between patients with diabetes mellitus and patients without it. Among the 195 patients with a solitary HCC lesion measuring < or = 3 cm in greatest dimension, the survival of the 32 patients with diabetes mellitus was significantly poorer than that of the 163 patients without diabetes mellitus (P = 0.0273), despite no apparent difference in liver function between the 2 groups. On multivariate analysis, diabetes mellitus was found to be an independent factor predicting lower survival after treatment (P = 0.0077) among patients with a solitary HCC lesion measuring < or = 3 cm in greatest dimension. No difference in the rate of recurrence was observed between the two groups in all the patients and in those patients with a solitary HCC lesion measuring < or = 3 cm in greatest dimension. CONCLUSION: The results of the current study indicated that the presence of diabetes mellitus worsens the prognosis of patients with a solitary HCC lesion measuring < or = 3 cm in greatest dimension; it appears to impact prognosis in patients with HCC when HCC is treatable, based on the size and the number of lesions. However, diabetes mellitus did not appear to affect the prognosis in the general population of patients with HCC. Based on the current study data, diabetes mellitus does not appear to modify the progression of HCC and its recurrence after treatment, but it does appear to worsen the prognosis of patients with HCC by means of a rapid decline in remnant liver function caused by repeated treatment of HCC.

Aged↗
PubMed2001

Prognosis in four syndromes of pregnancy-related pelvic pain.

BACKGROUND: The aim of the present study was to describe, on the basis of specific classification criteria and for a period of two years after delivery, the prognosis for women suffering from pregnancy-related pelvic joint pain, and to describe the characteristics influencing the prognosis. METHODS: One thousand seven hundred and eighty-nine pregnant women who were booked for delivery at Odense University Hospital formed a cohort to investigate the prognosis. Women whose reported daily pain from pelvic joints could be objectively confirmed were divided, according to symptoms, into five subgroups (n=405) - four classification groups (pelvic girdle syndrome, symphysiolysis, one-sided sacroiliac syndrome and double-sided sacroiliac syndrome) and one miscellaneous. The women in the five subgroups were re-examined at regular intervals for two years after delivery or until disappearance of symptoms (whichever was less). Thre hundred and forty-one women from the 5 subgroups participated in the postpartum follow-up. RESULTS: The majority (62.5%) of women in the four classification groups experienced disappearance of pain within a month after delivery. Two years after parturition 8.6% were still suffering from pelvic joint pain (determined subjectively and objectively). Persistence of pain was found to vary significantly from one classification group to another. None of those initially classified as suffering from symphysiolysis had pain 6 months after delivery in comparison to the 21 percent of those with pelvic girdle syndrome who continued to have pain at the two-year mark. CONCLUSIONS: This study shows that pregnancy-related pelvic joint pain had an excellent postpartum prognosis (in general) in three out of four classification groups. The women with pelvic girdle syndrome (pain in all 3 pelvic joints) had a markedly worse prognosis than the women in the other three classification groups. High number of positive test and a low mobility index were identified as giving the highest relative risk for long term pain.

Adult↗
PubMed2001

Microsatellite instability in sporadic colon cancer is associated with an improved prognosis at the population level.

Some previous studies have reported an improved prognosis in sporadic colon cancers with microsatellite instability, whereas others have not. In addition, relatively few of those reporting an improved prognosis controlled for tumor stage or were population-based. Therefore, we evaluated the relationship between microsatellite instability and prognosis, tumor stage, and other clinical variables in a population-based study of 1026 individuals. Microsatellite instability was determined by the noncoding mononucleotide repeat BAT-26 and the coding mononucleotide repeat in transforming growth factor-beta receptor type II. Significant relationships were seen between microsatellite instability and proximal tumor location, female gender, young and old age at diagnosis, poor histological differentiation, and low tumor stage (P < 0.01). There was a significant relationship between microsatellite instability and improved prognosis, even after adjusting for stage, with a reduction in the risk of death attributable to colon cancer of approximately 60%. Most of this risk reduction occurred in individuals with American Joint Committee on Cancer stage III tumors, although transforming growth factor-beta receptor type II mutations were associated with a significant reduction in colon cancer death in tumors with distant metastases. We conclude that microsatellite instability in sporadic colon cancer is associated with an improved prognosis at the population level.

Adult↗
PubMed2001

A new prognosis factor analysis based on nonhomogeneous Markov description.

To evaluate prognosis factors, Cox's proportional hazard model has been used. But it was found that the analytical ability was not sufficient. So we propose a new evaluation method combining Markov chain model and multiple logistic regression analysis to estimate the prognosis factors. Stage II breast cancer was chosen as the subject. The data was retrospective data gathered in National Cancer Center Central Hospital. As first step, a simple Markov chain model was constructed to describe the state transition of a breast cancer. Then the multiple property of each state transition was investigated in detail. And the patients who had gotten a recurrence for the first two and a half years were discriminated as the poor prognosis group by a nonparametric test (p < 0.05). And the result proved to corresponding with the clinical experience. As second step, three factors (n classification of pathological diagnosis, ductal spread, and estrogen receptor) were selected as the prognosis factors for the early death in Stage II breast cancer by a multiple logistic regression analysis. This new prognosis factor analysis could find out some scientific evidences. Especially, it was found to be remarkable efficient in proving clinically experienced observation.

Breast Neoplasms↗
PubMed2001

[Prognosis disclosure].

Doctors usually prefer telling the patients diagnosis and therapy than prognosis. Prognostication in fact means foretelling the future, while clinical interventions are scientifical clinical facts. Doctors are accustomed to speak about future only in probabilistic, statistical ways, while the patients ask about their own specific future; so the communication often can become very hard. The prognosis has to do with patient's quality of life, not only with natural history of disease; therefore it is important to establish with the patient a partnership: prognosis must be in fact a common building. A correct prognosis is necessary in informed consent: the outcome of medical intervention must be presented to patients in terms of effects on future quality of life. Prognosis is a very important relational tool: so communication and counselling skills are necessary in medical profession.

Humans↗
PubMed2001

[Clinicopathologic features and prognosis of lymphoepithelioma-like carcinoma of the lung].

OBJECTIVE: To analyze the clinicopathologic features and prognosis of lymphoepithelioma-like carcinoma (LELC) of the lung. METHODS: 26 cases of pulmonary LELC with available long-term follow-up information were compared with 84 cases of pulmonary non-LELC(33 cases of squamous cell carcinoma, 36 cases of adenocarcinoma, 6 cases of adeno-squamous carcinoma and 9 cases of large cell carcinoma) with available long-term follow-up information using Kaplan-Meier method and the generalized Wilcoxon test. RESULTS: LELC of the lung had a better prognosis than non-LELC (P < 0.05). Further study showed that pulmonary LELC had a significantly better prognosis than adeno-squamous carcinoma and large cell carcinoma. However, there was no significant prognostic differences between pulmonary LELC and squamous cell carcinoma and adenocarcinoma. Tumor recurrence and necrosis (> or = 5% of tumor) were associated with poor prognosis. CONCLUSION: Pulmonary LELC, which is a very rare and unique entity, has a better prognosis after therapy.

Adult↗
PubMed1999

[Relationship between the prognosis of retinal detachment in emmetropic eyes and vitreous changes].

OBJECTIVE: To study the relationship between surgical prognosis of retinal detachment (RD) in emmetropic or myopic eyes and vitreous changes. METHODS: Postoperatively, 1,294 eyes of 1,262 patients with rhegmatogenous RD including 243 emmetropic and 1,031 myopic eyes were retrospectively studied. The affects of proliferative vitreoretinopathy (PVR), posterior vitreous detachment (PVD), vitreous liquefaction and concentration on the surgical prognosis were evaluated. RESULTS: The cure rate in emmetropic group (88.5%) was lower than that in myopic group (93.8%, P < 0.01). Also, the cure rate by initial surgery in emmetropic group (65.4%) was lower than that in myopic group (76.4%, P < 0.01). In addition, the occurrences of PVD (39.6%) and liquefaction (76.1%) in emmetropic group were lower than that in myopic group (51.7%, and 81.8% respectively, P < 0.05). However, focal vitreous concentration in emmetropic group (56.8%) was much higher than that in myopic group (19.6%, P < 0.01). CONCLUSIONS: The surgical prognosis of RD especially by initial operation is worse in emmetropic group than that in myopic group. The lower occurrences of PVD and liquefaction but higher occurrence of focal vitreous concentration in emmetropic eyes may have impact on the prognosis. It is possible that the vitreous characteristics in emmetropic eyes with RD have relationship to the occurrence and development of PVR that has the influence on the prognosis to some extent.

Adolescent↗
PubMed1999

[Immunocyte reaction in stage III nasopharyngeal carcinoma in relation to biological findings and prognosis].

OBJECTIVE: To study the relationship between macrophages (MP), Langerhans cells (LC), T and B lymphocytes, biological behavior and prognosis of stage III nasopharyngeal carcinoma (NPC) patients. METHODS: 43 cases with stage III NPC were studied by immunohistochemical SP staining methods. RESULTS: The positive expression rates of infiltrating LC and/or MP in NPC were 41%, 65% (CD68+), 46% (lysozyme+), and were related to prognosis, but not to age, sex, metastasis to cervical lymph nodes and basi-cranial destruction and/or cranial nerve damage. In addition, infiltrating T or B cells in NPC were not related to the prognosis or biological behavior. However, when both infiltrating T lymphocytes and LC and/or MP were marked, the prognosis of these cases were better than that of those cases whose infiltrating LC and/or MP were marked but T cell infiltration was scarce. CONCLUSION: The prognosis of stage III NPC is related to LC or MP, survival is especially longer in those with marked T cell infiltration.

Adult↗
PubMed2002

[Prognosis of primary cutaneous lymphomas].

INTRODUCTION: The assessment of prognosis is a major step in the management of primary cutaneous lymphomas, as it allows to give patients an accurate information and it directs the treatment choice. MATERIAL AND METHODS: We performed a literature review of global prognosis and prognostic factors in primary cutaneous lymphomas. We used survival as the main endpoint, in particular specific survival and relative survival which provide accurate estimates of lymphoma-related deaths. Independent prognostic factors identified by multivariate survival analyses were emphasized. RESULTS: Overall prognosis of mycosis fungoides has improved during the past decades, possibly because of an increased proportion of cases diagnosed at early stages. Five-year disease-specific or relative survival rates of patients with T1 stage (patch/plaque disease<10 p. 100 of total skin surface), T2 (> 10 p. 100), T3 (tumor stage) and T4 (generalized erythroderma) are 100 p. 100, 67 to 96 p. 100, 51 to 80 p. 100 and 41 p. 100 respectively. Lymphomatoid papulosis and CD30+ primary cutaneous large T-cell lymphomas have an excellent prognosis, with 5-year survival rates of 100 p. 100 and 96 p. 100 respectively. CD30-negative primary cutaneous large T-cell lymphomas have an aggressive clinical behavior (5-year disease-specific or relative survival: 15 to 21 p. 100). Among primary cutaneous B-cell lymphomas, immunocytomas and marginal-zone B-cell lymphomas are not life-threatening. Follicle center-cell lymphomas that arise on the head and trunk have also an indolent clinical course (5-year specific survival rates: 94 to 97 p. 100). However, few of these lymphomas are composed of more than 50 p. 100 of large cells with round nuclei (centroblasts and/or immunoblasts) and may have a more aggressive clinical course (5-year specific survival: 72 p. 100). Large B-cell lymphomas of the leg often occur in older patients and have a poorer prognosis (5-year specific survival rate: 52 p. 100). Cases with a single lesion and those with a predominance of large cleaved cells (large centrocytes) have a more favorable clinical course than those with multiple tumors or a round cell morphology. CONCLUSION: Clinical, histological and immunophenotypical prognostic factors which have been identified so far may reliably predict the survival outcome in primary cutaneous lymphomas. On this basis, therapeutic guidelines have been proposed. These prognostic data will have to be taken into account when evaluating new potential prognostic factors (e.g. immunophenotypic or molecular) and performing prospective clinical trials.

Humans↗
PubMed2002

[Analyzing of prognosis of intestinal T-cell lymphoma].

OBJECTIVE: To investigate the roles of different clinicopathological features and expression of EBV genome in prognosis of intestinal T-cell lymphoma (ITCL). METHODS: Polymerase chain reaction for TCR-gamma gene rearrangement, in situ hybridization for EBER1/2 and immunohistochemical staining for CD4, CD8, CD45RO, CD56, TIA-1 were investigated and all patients followed-up. The LMP-1 expression was determined in forty-two ITCLs cases. The relationship between clinical data, different clinicopathological features, expression of EBV genome and prognosis were analyzed by SPSS10.0 program. RESULTS: (1) All 42 cases of ITCL had an extremely poor prognosis with a median survival of 3.0 months, of which the one year survival rate and two year survival rate being 30% and 22% respectively. (2) The patients without TCR-gamma gene rearrangements showed poorer prognosis than those with TCR-gamma gene rearrangements, and the patients who received operation and chemotherapy showed better prognosis than those who only received operation (P < 0.05). (3) No significant prognostic factor for ITCLs was determined. CONCLUSION: The special clinicopathological features of ITCL could be due to the cytotoxic function and the role of EBV infection in the pathogenesis of ITCL.

Adolescent↗
PubMed2002

[Visual prognosis in polypoidal choroidal vasculopathy associated with subretinal hematoma].

PURPOSE: Although it is reported that the prognosis for polypoidal choroidal vasculopathy(PCV) is better than that for age-related macular degeneration, visual acuity is not always good in eyes with subfoveal hemorrhage. We evaluated the factors that may affect the visual prognosis after subfoveal hematoma associated with PCV. SUBJECT: We examined retrospectively the records of 37 eyes in 34 patients that were diagnosed as PCV by indocyanine green angiography from January 1998 to July 2000 at Kyoto University Hospital. Among the 37 eyes, we chose 15 eyes in 15 patients that had subfoveal hematoma of more than 1 disk diameter, and evaluated the area of hematoma, period required for absorption of the hematoma, association of choroidal neovascularization(CNV), treatment, and visual acuity change. RESULTS: The area and the absorption period of the hematoma did not correlate with the visual prognosis. Association of CNV strongly influenced the visual outcome after the absorption of subretinal hemorrhage. Four eyes with CNV received various treatments, but no restoration of visual acuity was observed. CONCLUSION: CNV association mostly affected the prognosis of PCV with hematoma. Early detection of CNV appeared important to predict visual prognosis.

Aged↗
PubMed2002

[Classifications and prognosis of hepatocellular carcinoma].

In this study are included 78 patients with hepatocellular carcinoma (HCC). In 22 the diagnosis is verified pathologically (obduction), while in the other patients the diagnosis is made by laparoscopy, laparoscopical ultrasonography and morphological verification (through FNAB cytology and/or histology). In 69.2% HCC is associated with cirrhosis. The prognosis of HCC associated with cirrhosis is evaluated through the classification of S. Chevret et all., and is compared to the Child-Pugh scoring system. 38.9% of patients in Chevret's class C score are in class B in the Child-Pugh score, while 25.9% of patients are in class C in both classifications, but Child-Pugh's class C patients are most often in B-C transition. It might be assumed that the prognosis of HCC depends more on the tumor prognosis than on the prognosis of the liver cirrhosis itself. Every classification which does not take in to account the liver function (like TNM system) and the whole characteristics of the tumor, would be incomplete, in some extent, in the prognosis of HCC with cirrhosis. In HCC without cirrhosis, the BCLC classification reflects both the liver function and the tumor characteristics. In BCLC class A patients hepatic resection or transplantation is recommended but hyperbilirubinemia and ascites, which might be seen in A3 and A4 classes contraindicate resection of the liver. All scoring systems define lower HCC stage than it is really found (personal and reference data), so there are no arguments to take classification scores as absolute treatment decision making rules.

Adult↗
PubMed2003

[Multivariate analysis of prognosis of patients with clinical stage I and II carcinoma of mobile tongue].

BACKGROUND & OBJECTIVE: There are many factors affecting the prognosis of the patients with clinical stage I and II carcinoma of mobile tongue. This study was designed to analyze the most important factors affecting the prognosis. METHODS: The data of long period follow-up were analyzed retrospectively for 147 patients with clinical stage I and II squamous cell carcinoma of mobile tongue to evaluate the contribution of every factors influencing on survival. Survival analysis was performed by life table method; comparison among/between groups was performed using log-rank test; multivariate analysis was carried out using Cox proportional hazard model and Logistic regression model. RESULTS: Univariate analysis showed that pathological grade (G2 and G3), status of cervical lymph node, pathological stage (stage III and IV), history of alcohol consumption, primary location recurrence, regional recurrence, primary location and regional recurrence, and cancer recurrence were risk factors of the prognosis of the patients (P< 0.05). Multivariate analysis showed that locoregional recurrence (P=0.000) and pathological stage (P=0.045) could predict the prognosis. The result of Logistic regression model indicated that status of cervical lymph node (P=0.003) and history of alcohol consumption (P=0.012) were closely associated with locoregional recurrence. CONCLUSION: Locoregional recurrence and pathological stage(stage III and IV) are the most important factors affecting the prognosis of the patients with clinical stage I and II squamous cell carcinoma of mobile tongue. The risk factors affecting locoregional recurrence of the patients are positive cervical lymph node and history of alcohol consumption.

Adult↗
PubMed2003

[Expression of matrix metalloproteinase 9 (MMP-9) and laminin-receptor in breast carcinoma and their correlation with tumor metastasis and prognosis].

BACKGROUND & OBJECTIVE: Previous researches of breast cancer mainly focused on its parenchyma and prognosis; however, the relationship between extracellular matrix of breast carcinoma and metastasis as well as prognosis was still unknown. The present study was designed to investigate the expression of matrix metalloproteinase 9 (MMP-9) and laminin- receptor (LM-R) in breast carcinoma and their correlation with tumor metastasis and prognosis. METHODS: The immunohistochemical method was applied to examine the expression of MMP-9 and LM-R in 80 samples of breast carcinoma and 10 breast tissues of hyperplasia. The absorbance(A) values that indicate the expression levels were analyzed by computer image technique. t-test, chi square-test and other related tests were used to analyze their relationship with tumor metastasis and prognosis. RESULTS: The expression of MMP-9 in breast carcinoma was apparently higher than that in hyperplasia (t=8.87, P< 0.05). LM-R expressed at the basal membrane and the edge of some acini and ducts in hyperplasia tissues, while expressed at cytoplasm and cellular membrane in breast carcinoma tissues. LM-R expression of tumor in 17 cases with LM-R expression in basal membrane was higher than that in those without LM-R expression in basal membrane (t=2.02, P< 0.05). LM-R expression was related to histological grade; the lower the degree of differentiation, the higher the expression level (F=3.27, P< 0.05). The expression of MMP-9 and LM-R related to lymphatic metastasis. The expression levels of MMP-9 and LM-R in the group which had more than 3 involved lymph node were lower than those in the group which had less than involved 3 lymph node and no involved lymph node (t(MMP-9)=3.42, t(LM-R)=4.31, P< 0.05). The expression of MMP-9 and LM-R in original focus had significantly positive relation to metastasis(r(MMP-9)=0.654, r(LM-R)=0.755, P< 0.001). MMP-9 had negative relation to progestogen receptor (PR) (r=-0.363,P< 0.05) and positive relation to LM-R (r=0.503,P< 0.01). The expression levels of MMP-9 and LM-R of the group which survived more than 3 years were lower than that in the group which survived less than 3 years (t(MMP-9)=3.57, t(LM-R)=4.22, P< 0.05). Both of MMP-9 and LM-R were negatively related to the survival of the patients with breast carcinoma (r(MMP-9)=-0.387, r(LM-R)=-0.369, P< 0.05). CONCLUSION: MMP-9 and LM-R are useful indexes for predicting the metastasis and prognosis of breast cancer.

Breast Neoplasms↗
PubMed2003

Prognosis of primary liver carcinoma treated with local resection.

OBJECTIVE: To discuss the prognosis of primary liver carcinoma treated with local resection and factors affecting prognosis. METHODS: The data of 130 patients who had been treated from October 1989 to October 1995 were analyzed retrospectively. We analyzed the concrete operating methods, the cause of postoperative complications and factors affecting prognosis. RESULTS: Curative local resection was performed in 130 patients. Operation-related mortality was 0.8% and the incidence of complication was 16.1% (n = 18). The overall 1-, 3- and 5-year survival rates were 82.1%, 60.6% and 48.2%, respectively. Involvement of blood vessels or liver capsules and the elevation of AST before operation were the significant factors affecting prognosis (P < 0.05). CONCLUSION: Local resection is a safe method characterized by little damage, rapid, less blood loss, low complication rate and good prognosis.

Adult↗
PubMed2003

[Factors of an unfavorable prognosis in patients with B-cell chronic lymphoid leukemia: a retrospective analysis of 206 cases].

AIM: To assess factors of an unfavourable prognosis in a group of intermediate risk of B-cell chronic lymphoid leukemia (BCCLL). MATERIAL AND METHODS: 206 BCCLL patients (mean age 55.5 years, male/female = 1.66) entered the study conducted by Hematological Research Center in 1992-2000. RESULTS: Nine patients under 35 years of age did not survive 5 years except one female who achieved a complete remission on fludarabin. The type of bone marrow infiltration (diffuse vs interstitial and nodular), the time of lymphocyte count doubling (under or over 12 months) discriminate the patients by prognosis in the group of intermediate risk: medians of overall survival 65 months vs 148 months and 72 vs 133 months, respectively (p < 0.005 for both curves, log-rank criterion). Survival medians in groups with low (< 50% cells) and high (> 50% cells) expression of CD38+ cells in the group of intermediate BCCLL risk comprise 55 and 106 months (p = 0.005). The type of bone marrow infiltration and time of doubling of lymphocyte count overlap: > 70% patients with a diffuse type of bone marrow infiltration have the time of doubling under 12 months and vice versa while expression of CD38 do not overlap with these values. Combination of two signs (type of bone marrow infiltration and CD38 expression or time og lymphocyte count doubling and CD38 expression) allows more precise identification of prognostically unfavourable groups. Medians of survival for combination of the first two signs (two positive against two negative) comprise 51 months vs 169 months (p < 0.0001), for combination of the latter two signs 55 months vs 106 months was not reached (p < 0.001). Although most patients with a tumor form of BCCLL are referred to stage II, the prognosis in this form is much worse than in stage II, survival medians are 44 and 69 months, respectively (p < 0.05). A mutation status of the genes of a variable region of immunoglobulins enable identification of the group of patients with a relatively benign course of BCCLL (survival medians 61 and 289 months, p < 0.0001). CONCLUSION: In patients under 35 years of age BCCLL runs unfavourably and seems to require intensive polychemotherapy. Usage of a combination of the signs (CD38, time of doubling of lymphocyte count and type of bone marrow infiltration) is a simple and reliable method of identification of prognostically different categories of patients in the group of an intermediate BCCLL risk. Prognosis in patients with a tumor form of BCCLL is unfavourable: medians of survival in patients with a tumor form and stage III-IV are comparable. Mutational status of the genes of immunoglobulin variable region may serve a marker of a long-term prognosis.

Adolescent↗